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Article ; Online: Surgical Repair of a Left Main Coronary Artery to Right Ventricle Fistula in a Neonate.

Meshulami, Noy / Kaushik, Shubhi / Pastuszko, Peter / Murthy, Raghav

World journal for pediatric & congenital heart surgery

2023 Volume 15, Issue 1, Page(s) 128–130

Abstract: We describe the case of a newborn male with a large fistula from the left main coronary artery to the right ventricle. This case illustrates a rare congenital coronary artery fistula and its successful surgical management in the neonatal period. ...

Abstract	We describe the case of a newborn male with a large fistula from the left main coronary artery to the right ventricle. This case illustrates a rare congenital coronary artery fistula and its successful surgical management in the neonatal period.
MeSH term(s)	Infant, Newborn ; Humans ; Male ; Coronary Vessel Anomalies/diagnostic imaging ; Coronary Vessel Anomalies/surgery ; Heart Ventricles/surgery ; Heart Ventricles/abnormalities ; Fistula/diagnostic imaging ; Fistula/surgery ; Fistula/congenital
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2550261-X
ISSN	2150-136X ; 2150-1351
ISSN (online)	2150-136X
ISSN	2150-1351
DOI	10.1177/21501351231189281
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Anti-Xa testing for pediatric and neonatal patients on extracorporeal membrane oxygenation.

Meshulami, Noy / Green, Robert / Kaushik, Shubhi

Perfusion

2023 , Page(s) 2676591231185009

Abstract: Introduction: To determine if anti-Xa testing is associated with improved outcomes for patients <19-years-old on ECMO.: Methods: We evaluated the clinical benefit of anti-Xa heparin monitoring utilizing the Bleeding and Thrombosis during ECMO (BATE) ... ...

Abstract	Introduction: To determine if anti-Xa testing is associated with improved outcomes for patients <19-years-old on ECMO. Methods: We evaluated the clinical benefit of anti-Xa heparin monitoring utilizing the Bleeding and Thrombosis during ECMO (BATE) database of 514 patients <19-years-old. The BATE database includes incidences of bleeding, thrombosis, and mortality. The database also describes anti-coagulation test utilization. We grouped and analyzed patients based on ECMO indication (cardiac, respiratory, or extracorporeal cardiopulmonary resuscitation [E-CPR]) and age (neonatal vs pediatric). We constructed multivariable logistic regression models to analyze the impact of anti-Xa testing on mortality, bleeding, and thrombosis in each group. Results: Across the entire population, anti-Xa testing did not have a significant effect on the incidence of mortality (43% with anti-Xa testing vs 49% without), bleeding (68% vs 74%), or thrombosis (37% vs 39%). However, among cardiac indicated patients on ECMO ( Conclusion: Anti-Xa testing is associated with improved outcomes among cardiac indicated and neonatal patients on ECMO. Additional research to find the optimal heparin monitoring regimen is needed to better support these critically ill patients. In the interim, we recommend clinicians consider utilizing anti-Xa assays as part of their heparin monitoring plan for neonatal and cardiac indicated patients on ECMO.
Language	English
Publishing date	2023-06-20
Publishing country	England
Document type	Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591231185009
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Article ; Online: Antithrombin III supplementation during neonatal and pediatric extracorporeal membrane oxygenation.

Meshulami, Noy / Green, Robert / Kaushik, Shubhi

Artificial organs

2023 Volume 47, Issue 12, Page(s) 1848–1853

Abstract: Background: Bleeding and thrombosis are common extracorporeal membrane oxygenation (ECMO) complications associated with increased mortality. Heparin is the most commonly used ECMO anticoagulant, employed in 94% of cases. Reduced antithrombin III (AT3) ... ...

Abstract	Background: Bleeding and thrombosis are common extracorporeal membrane oxygenation (ECMO) complications associated with increased mortality. Heparin is the most commonly used ECMO anticoagulant, employed in 94% of cases. Reduced antithrombin III (AT3) levels could decrease heparin effectiveness. Neonates have inherently lower levels of AT3 than adults, and pediatric patients on ECMO can develop AT3 deficiency. One potential approach for patients on ECMO with AT3 deficiency is exogenous AT3 supplementation. However, there is conflicting data concerning the use of AT3 for pediatric and neonatal patients on ECMO. Methods: We analyzed the Bleeding and Thrombosis during ECMO database of 514 neonatal and pediatric patients on ECMO. We constructed daily regression models to determine the association between AT3 supplementation and rates of bleeding and thrombosis. Given the physiological differences between pediatric patients and neonates, we constructed separate models for each. Results: AT3 administration was associated with increased rates of daily bleeding among pediatric (adjusted odds ratio [aOR] 1.59, p < 0.01) and neonatal (aOR 1.37, p = 0.04) patients. AT3 supplementation did not reduce the rate of thrombosis for either pediatric or neonatal patients. Conclusion: AT3 administration was associated with increased rates of daily bleeding, a hypothesized potential complication of AT3 supplementation. In addition, AT3 supplementation did not result in lower rates of thrombosis. We recommend clinicians utilize caution when considering supplementing patients on ECMO with exogenous AT3.
MeSH term(s)	Infant, Newborn ; Adult ; Humans ; Child ; Antithrombin III ; Extracorporeal Membrane Oxygenation/adverse effects ; Retrospective Studies ; Anticoagulants/adverse effects ; Heparin/adverse effects ; Thrombosis/etiology ; Thrombosis/prevention & control ; Hemorrhage/chemically induced ; Hemorrhage/prevention & control ; Dietary Supplements
Chemical Substances	Antithrombin III (9000-94-6) ; Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2023-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	441812-8
ISSN	1525-1594 ; 0160-564X
ISSN (online)	1525-1594
ISSN	0160-564X
DOI	10.1111/aor.14639
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Zs.A 1463: Show issues

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Article: Cardiac transplantation in adult congenital heart disease: a narrative review.

Meshulami, Noy / Shah, Pritik / Kaushik, Shubhi / Murthy, Raghav

Journal of thoracic disease

2023 Volume 15, Issue 9, Page(s) 5074–5087

Abstract: Background and objective: As more children with congenital heart disease survive to adulthood, adult congenital heart disease (ACHD) prevalence will increase (currently ~1 million US patients). Heart failure (HF) accounts for 26-42% of ACHD deaths. The ... ...

Abstract	Background and objective: As more children with congenital heart disease survive to adulthood, adult congenital heart disease (ACHD) prevalence will increase (currently ~1 million US patients). Heart failure (HF) accounts for 26-42% of ACHD deaths. The rate of ACHD heart transplantations (ACHD HTx) is also increasing. We describe the ACHD HTx recipient/candidate cohort, analyze ACHD HTx outcomes, identify ACHD HTx specific challenges, and discuss opportunities to better serve more patients with ACHD HF. Methods: PubMed literature search including articles published from 2010-2023. Reviewed 89 studies, 67 included. Our search focused on the challenges of ACHD HTx and potential solutions. Key content and findings: ACHD HTx recipients are young [median age 35 years, interquartile range (IQR): 24-46 years]. 87-95% of ACHD HTx recipients had prior cardiac surgery. The most common underlying diagnoses include transposition of the great arteries (31%) and Fontan/Glenn circulation (28%). 63% of listed ACHD HTx candidates received a transplant within one year of listing. Post-transplant 1-year survival is 80%, 5-year survival 74%, and 10-year survival 59%. There are 4 unique ACHD HTx challenges: (I) difficulty in assessing pulmonary hypertension, resulting in some centers selecting oversized donor hearts. However, selecting oversized hearts does not improve post-operative mortality and could prolong waitlist time. (II) Increased immunologic sensitization, increasing rejection risk. Desensitization therapy has enabled sensitized HTx recipients to enjoy outcomes similar to non-sensitized recipients. (III) Procedural complexity with ~30% of cases requiring additional surgical reconstruction. Detailed multidisciplinary planning, extensive imaging, and transferring the patient into the operating room early can help manage the complexities and reduce organ ischemic time. (IV) Increased intraoperative bleeding due to patients' surgical histories and circulatory collaterals. Preoperative collateral coil embolization and select utilization of hypothermic circulatory arrest can help reduce bleeding. Additional Fontan specific challenges include extensive great artery repair, liver failure, plastic bronchitis, and protein loss enteropathy. Finally, given limited donor heart availability, mechanical circulatory support is a promising technology for patients with ACHD HF. Conclusions: The prevalence of ACHD HTx is slowly but steadily increasing. The operational complexity of ACHD HTx can be managed, and the majority of recipients have excellent outcomes (59% 10-year survival).
Language	English
Publishing date	2023-08-21
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-23-513
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Article ; Online: Reply.

Kaushik, Shubhi / Derespina, Kim R / Medar, Shivanand S

The Journal of pediatrics

2020 Volume 226, Page(s) 315

Keywords	covid19
Language	English
Publishing date	2020-07-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2020.07.064
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Article ; Online: Pericardiectomy for Successful Treatment of Constrictive Pericarditis in a Pediatric Patient.

Moss, Rachel / Ali, Amr Mohamed / Mahgerefteh, Joseph / Panesar, Laurie E / Pastuszko, Peter / Murthy, Raghav / Kaushik, Shubhi

JACC. Case reports

2023 Volume 23, Page(s) 102009

Abstract: A 15-year-old girl with history of asthma and obesity presented with recurrent anasarca without systolic heart failure or significant renal disease. She was diagnosed with constrictive pericarditis and successfully underwent pericardiectomy with ... ...

Abstract	A 15-year-old girl with history of asthma and obesity presented with recurrent anasarca without systolic heart failure or significant renal disease. She was diagnosed with constrictive pericarditis and successfully underwent pericardiectomy with pericardial stripping and a waffle procedure. (
Language	English
Publishing date	2023-10-04
Publishing country	Netherlands
Document type	Case Reports
ISSN	2666-0849
ISSN (online)	2666-0849
DOI	10.1016/j.jaccas.2023.102009
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Article ; Online: Bivalirudin anticoagulation for cardiopulmonary bypass during cardiac surgery.

Meshulami, Noy / Murthy, Raghav / Meyer, Maisy / Meyer, Andrew D / Kaushik, Shubhi

Perfusion

2023 , Page(s) 2676591231221708

Abstract: Introduction: Heparin is the primary anticoagulant for cardiopulmonary bypass (CPB) support during cardiac surgery. While widely used, ∼2% of cardiac surgery patients develop heparin-induced thrombocytopenia (HIT) and 4-26% develop heparin resistance. ... ...

Abstract	Introduction: Heparin is the primary anticoagulant for cardiopulmonary bypass (CPB) support during cardiac surgery. While widely used, ∼2% of cardiac surgery patients develop heparin-induced thrombocytopenia (HIT) and 4-26% develop heparin resistance. Bivalirudin is an alternative anticoagulant mainly used for percutaneous coronary interventions. Given the challenges associated with heparin anticoagulation, we conducted a review to explore the use of bivalirudin for CPB surgery. Methods: PubMed and Embase scoping review included 2 randomized controlled trials, a retrospective comparison study, 3 pilot studies, and 30 case reports. To provide a contemporary series, we searched for articles published from 2010 to 2023. Our review included studies from both adult and pediatric populations. Results: While data is limited, bivalirudin seems to supply similar effectiveness and safety as heparin for CPB anticoagulation. Across the three comparative studies, the heparin cohorts had a 0-9% mortality rate and 0-27% rate of major bleeding/reoperation compared to a 0-3% mortality and 0-6% major bleeding/reoperation rate for the bivalirudin cohorts. Bivalirudin was successfully used as an anticoagulant in a wide range of CPB surgeries (e.g., heart transplants, ventricular assisted device placements, and valve repairs). Successful patient outcomes were reported with bivalirudin infusion of ∼2 mg/kg/hour, activated clotting time monitoring (target >400 s or 2.5× baseline), use of cardiotomy suctions, minimization of stagnant blood, and post-bypass modified ultrafiltration. Conclusion: Bivalirudin is a safe and effective anticoagulant for CPB, especially for patients with HIT or heparin resistance. Further comparative research is called for to optimize bivalirudin utilization for CPB during cardiac surgery.
Language	English
Publishing date	2023-12-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591231221708
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Article ; Online: Response to "Thiamin deficiency secondary to loop diuretics, an overlooked cause of multiorgan failure".

Derespina, Kim R / Kaushik, Shubhi / Mahadeo, Kris / McCabe, Megan

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

2021 Volume 36, Issue 5, Page(s) 1088–1089

MeSH term(s)	Heart Failure ; Humans ; Sodium Potassium Chloride Symporter Inhibitors ; Thiamine ; Thiamine Deficiency
Chemical Substances	Sodium Potassium Chloride Symporter Inhibitors ; Thiamine (X66NSO3N35)
Language	English
Publishing date	2021-08-31
Publishing country	United States
Document type	Letter
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1002/ncp.10766
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Article ; Online: The Practice and Complications of Midline Catheters: A Systematic Review.

Tripathi, Sandeep / Kumar, Shruti / Kaushik, Shubhi

Critical care medicine

2021 Volume 49, Issue 2, Page(s) e140–e150

Abstract: Objective: Midline catheters are considered "midway" regarding vascular access. The objective of this systematic review was to explore the current practice, dwell time, and complication rates of midline catheters.: Design: Systematic review.: ... ...

Abstract	Objective: Midline catheters are considered "midway" regarding vascular access. The objective of this systematic review was to explore the current practice, dwell time, and complication rates of midline catheters. Design: Systematic review. Setting: Search on four databases, PubMed, CINAHL, Scopus, and Embase, were conducted for English language articles published after the year 2000. Measurements and main results: A total of 987 articles were identified, of which 31 manuscripts met the inclusion criteria and were selected for review. Quality assurance was performed based on the Newcastle-Ottawa score. Average dwell time and complication rates were calculated for studies involving adult patients and adjusted for sample size. This analysis included data from the placement of 18,972 midline catheters across five countries. Aside from two randomized control trials, most of the studies analyzed were cohort studies. One pediatric and two neonatal studies were included. The average dwell time was 16.3 days (n = 4,412). The adjusted mean infection rate was 0.28/1,000 catheter days, with 64% of studies not reporting any infection with midline catheter. The failure rate of midline catheters was 12.5%. Adjusted average rates of other significant complications included the following: deep vein thrombosis (4.1%), dislodgement (5.0%), occlusion (3.8%), phlebitis (3.4%), and infiltration (1.9%). Conclusions: The dwell times and failure rates of midline catheters compare favorably against published data on other types of catheters. Their infection rates are also lower than the reported rates of central venous catheters; however, they have a higher rate of mechanical complications. Active surveillance of infections due to midline catheters is recommended. More data are needed from pediatric and neonatal populations.
MeSH term(s)	Adult ; Catheter Obstruction/etiology ; Catheter-Related Infections/etiology ; Catheter-Related Infections/prevention & control ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/methods ; Catheters, Indwelling/adverse effects ; Catheters, Indwelling/statistics & numerical data ; Child ; Critical Care/statistics & numerical data ; Humans ; Infant, Newborn ; Risk Factors ; Sepsis/prevention & control
Language	English
Publishing date	2021-01-09
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000004764
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Article ; Online: Reply.

Kaushik, Shubhi / Jhaveri, Simone / Derespina, Kim R / Medar, Shivanand S / Stern, Kenan / Aydin, Scott I

The Journal of pediatrics

2020 Volume 228, Page(s) 315–316

Language	English
Publishing date	2020-11-02
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2020.09.055
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